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Randomized controlled trial to determine whether mirror therapy (MT), added to conventional physiotherapy, improves upper-limb motor recovery, hand function, spasticity, and range of motion (ROM) in acute stroke compared with conventional physiotherapy alone. Outcomes include ARAT, Motor Assessment Scale, Modified Ashworth Scale, and goniometric ROM.
Stroke causes significant upper-limb impairment in the acute stage; early, targeted rehabilitation leverages heightened neuroplasticity. Mirror therapy uses a mid-sagittal mirror to reflect movements of the non-paretic limb, creating the illusion of normal movement in the paretic limb, recruiting mirror neuron circuits and facilitating motor relearning. Prior work suggests MT can improve fine and gross motor skills, reduce spasticity, and increase active ROM. This trial operationalizes a pragmatic MT protocol integrated with standard inpatient/outpatient physiotherapy in acute stroke.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mirror Therapy + Conventional Physiotherapy | Experimental | Experimental: Mirror Therapy + Conventional Physiotherapy Device/Procedure: Mirror Therapy (20 min/session) + immediate Conventional Physiotherapy (20 min/session) Schedule: 2 sessions/week for 1 week (total: 2 sessions) MT Procedure: Mirror (box or plain) placed along mid-sagittal plane reflecting the non-paretic limb while hiding the paretic limb. Participants perform bilateral symmetrical movements focusing on the mirror image (e.g., wrist flex/ext, finger flex/ext, elbow flex/ext, reaching & grasping). Conventional Content (immediately after MT): strengthening & functional task practice (e.g., reaching/transfers), plus targeted hand training: theraputty squeezes, finger extension with rubber band, towel wringing, lifting small objects, reaching overhead/side-to-side with weight, weighted ball toss/catch. |
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| Conventional Physiotherapy Only | Active Comparator | Procedure: Conventional Physiotherapy (20 min/session), no mirror. Same schedule and exercise menu as above without visual mirror feedback. Notes: The proposal specifies 1 week duration with 2 sessions/week, 20 min each; centers may extend to clinically standard dosage via protocol amendment if needed. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mirror Therapy Conventional Physiotherapy | Behavioral | Experimental: Mirror Therapy + Conventional Physiotherapy Mirror therapy performed 20 min/session, 2 sessions/week for 1 week. A mirror is placed midsagittal, reflecting the non-paretic limb while hiding the paretic limb. Patients perform bilateral movements (wrist, finger, elbow flex/extension; reaching/grasping) while focusing on the mirror image. This is followed by 20 min of conventional physiotherapy, including strengthening, functional tasks, theraputty squeezes, finger extension with rubber band, towel wringing, lifting small objects, overhead reaching, and ball toss. Active Comparator: Conventional Physiotherapy Only Conventional physiotherapy 20 min/session, 2 sessions/week for 1 week. Exercises include upper limb strengthening, functional task practice, theraputty squeezes, finger extension with rubber band, towel wringing, lifting small objects, overhead reaching, and ball toss. |
| Measure | Description | Time Frame |
|---|---|---|
| Upper-Limb Function (ARAT total score, 0-57) | Change from baseline to end of week 1; higher scores = better function. | 6 Months |
| Measure | Description | Time Frame |
|---|---|---|
| Motor Function (Motor Assessment Scale - relevant upper-limb items, 0-6 per item) | Change baseline→week 1; higher = better. | 6months |
| Measure | Description | Time Frame |
|---|---|---|
| Spasticity (Modified Ashworth Scale, 0-4) | Change baseline→week 1; lower = less spasticity. | 6 months |
| Range of Motion (Goniometric AROM at shoulder, elbow, wrist, finger joints; degrees) | Change baseline→week 1; higher = improved ROM. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dr.Nadeem Ahmad, MS | Contact | 03451915105 | n.ahmad@riphah.edu.pk | |
| Dr.Nadeem Ahmad, MS | Contact | 03028367237 | drnadeem765@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Dr.Nadeem Ahmad, MS | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Riphah international University Malakand Campus | Recruiting | Malakand | KPK | 23060 | Pakistan |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D008722 | Methods |
| ID | Term |
|---|---|
| D008919 | Investigative Techniques |
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Parallel Assignment (2 arms)
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None (Open Label)
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| 6 months |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |